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Jafari-Golestan N, Dalvandi A, Hosseini M, Fallahi-Khoshknab M, Ebadi A, Rahgozar M, Souraya S. Designing and validating of a questionnaire measuring perceived self-care ability (PSCA) in chronic stroke patients at home. BMC Neurol 2024; 24:125. [PMID: 38622553 PMCID: PMC11017699 DOI: 10.1186/s12883-024-03612-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 03/26/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND Patients with a stroke often cannot care for themselves after hospital discharge. Assessment of their self-care ability is the first step in planning post-discharge home care. This study aimed to design and validate a measure of perceived self-care ability (PSCA) in stroke patients. METHODS A sequential-exploratory mixed method was conducted in Tehran, Iran, in 2020-2021. The qualitative phase involved in-depth semi-structured interviews with 12 participants. Transcripts were content analyzed. The results guided the development of 81 items. psychometric properties such as face validity (Impact Score > 1.5), content validity ratio (CVR > 0.63), content validity index (Item Content Validity Index: ICVI > 0.78, Scale Content Validity Index/Average: SCVI/Ave > 0.8) and Kappa value (Kappa > 0.7), internal consistency (Cronbach's alpha > 0.7), relative reliability (ICC: inter class correlation coefficient), absolute reliability (Standard Error of Measurement: SEM and Minimal Detectable Changes: MDC), convergent validity (Correlation Coefficient between 0.4-0.7), interpretability, responsiveness, feasibility, and ceiling and floor effects were assessed. RESULTS Content analysis of the qualitative interviews yielded 5 major categories and 9 subcategories that reflected "Perceptual stability", "Cognitive fluctuations", "Sensory, Motor and Physical health"," The subjective nature" and "The dynamic nature" of PSCA. Results of face and content validity reduced the number of items to 32, capturing three dimensions of PSCA in chronic stroke patients; these dimensions included perceptual ability, threatened health status, and sensory, motor, and cognitive ability. The findings supported the reliability and validity of the measure. CONCLUSIONS The PSCA questionnaire was developed and validated within the Iranian culture. It is useful in assessing the self-care of patients with stroke and in informing practice.
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Affiliation(s)
- Nasrin Jafari-Golestan
- Faculty of Nursing, Department of Nursing Management, Aja University of Medical Sciences, Tehran, IR, Iran
| | - Asghar Dalvandi
- Department of Midwifery, Faculty of Nursing and Midwifery, Islamic Azad University, Tehran, IR, Iran.
- Department of Nursing Education, University of Social Welfare and Rehabilitation Sciences, Tehran, IR, Iran.
| | - Mohammadali Hosseini
- Department of Nursing Education, University of Social Welfare and Rehabilitation Sciences, Tehran, IR, Iran
| | - Masoud Fallahi-Khoshknab
- Department of Nursing Education, University of Social Welfare and Rehabilitation Sciences, Tehran, IR, Iran
| | - Abbas Ebadi
- Behavioral Sciences Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, IR, Iran
- Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, IR, Iran
| | - Mahdi Rahgozar
- Department of Biomedical Statistics, University of Social Welfare and Rehabilitation Sciences, Tehran, IR, Iran
| | - Sidani Souraya
- School of Nursing, Toronto Metropolitan University, Toronto, Canada
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Moulaei K, Dinari Z, Dinari F, Jahani Y, Bahaadinbeigy K. The role of social networks in diabetes self‐care: A cross‐sectional study. Health Sci Rep 2022; 5:e601. [PMID: 35509403 PMCID: PMC9059190 DOI: 10.1002/hsr2.601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 01/27/2022] [Accepted: 03/04/2022] [Indexed: 11/12/2022] Open
Abstract
Background Patient involvement with diabetes self‐care is critical to reducing complications, morbidity, and mortality. Social media, as one of the most important forms of digital health, has always been available for diabetes self‐care, although the role of these media in supporting patient self‐care is unclear. Aims The aim of this study was to investigate the role of social networks in diabetes self‐care. In this study, the most important social networks used to receive self‐care services, diabetes self‐care behaviors, diabetes self‐care educations and benefits of using various services provided through social networks were identified. Methods The present study is a cross‐sectional study that was conducted through an electronic researcher‐made questionnaire in 2021. Two hundred and eighteen patients were selected to participate in the study from centers of diabetes of Fasa city, south of Iran. Sampling was performed by convenience sampling and in accordance with inclusion and exclusion criteria. Data were analyzed by descriptive statistics and analytical tests. Results In the data analysis section on Diabetes self‐care behaviors, there was no significant relationship between gender (p = 0.292), age (p = 0.49), type of diabetes (p = 0.909) and duration of diabetes (p = 0.076) with the use of self‐care services provided through social networks. There was a significant relationship between education level and the use of self‐care services provided through social networks (p = 0.01). “Recognizing diabetes and its complications,” “observing personal hygiene,” and “the impact of physical activity on diabetes control” were the most important educations. “Increasing patient knowledge and understanding about diabetes and its complications,” “reducing the consumption of high‐calorie foods and sugars,” and “observing personal and public health” were the most important social network's benefits, respectively. Conclusions Various self‐care educations and services provided through social networks can increase the in‐depth knowledge of diabetic patients about self‐care techniques and their effective role in controlling and managing diabetes and performing more self‐care processes.
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Affiliation(s)
- Khadijeh Moulaei
- Faculty of Management and Medical Information Sciences, Student Research Committee Kerman University of Medical Sciences Kerman Iran
| | - Zahra Dinari
- Faculty of Psychology and Educational Sciences Marvdasht University of Islamic Azad Marvdasht Iran
| | - Fatemeh Dinari
- Faculty of Management and Medical Information Sciences, Student Research Committee Kerman University of Medical Sciences Kerman Iran
| | - Yunes Jahani
- Modeling in Health Research Center, Institute for Futures Studies in Health Kerman University of Medical Sciences Kerman Iran
| | - Kambiz Bahaadinbeigy
- Medical Informatics Research Center, Institute for Futures Studies in Health Kerman University of Medical Sciences Kerman Iran
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Cairo Notari S, Sader J, Caire Fon N, Sommer JM, Pereira Miozzari AC, Janjic D, Nendaz M, Audétat MC. Understanding GPs' clinical reasoning processes involved in managing patients suffering from multimorbidity: A systematic review of qualitative and quantitative research. Int J Clin Pract 2021; 75:e14187. [PMID: 33783098 PMCID: PMC8459259 DOI: 10.1111/ijcp.14187] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 03/25/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Most consultations in primary care involve patients suffering from multimorbidity. Nevertheless, few studies exist on the clinical reasoning processes of general practitioners (GPs) during the follow-up of these patients. The aim of this systematic review is to summarise published evidence on how GPs reason and make decisions when managing patients with multimorbidity in the long term. METHODS A search of the relevant literature from Medline, Embase, PsycINFO, and ERIC databases was conducted in June 2019. The search terms were selected from five domains: primary care, clinical reasoning, chronic disease, multimorbidity, and issues of multimorbidity. Qualitative, quantitative, and mixed-methods studies published in English and French were included. Quality assessment was performed using the Mixed Methods Appraisal Tool. RESULTS A total of 2 165 abstracts and 362 full-text articles were assessed. Thirty-two studies met the inclusion criteria. Results showcased that GPs' clinical reasoning during the long-term management of multimorbidity is about setting intermediate goals of care in an ongoing process that adapts to the patients' constant evolution and contributes to preserve their quality of life. In the absence of guidelines adapted to multimorbidity, there is no single correct plan, but competing priorities and unavoidable uncertainties. Thus, GPs have to consider and weigh multiple factors simultaneously. In the context of multimorbidity, GPs describe their reasoning as essentially intuitive and seem to perceive it as less accurate. These clinical reasoning processes are nevertheless more analytical as they might think and rooted in deep knowledge of the individual patient. CONCLUSIONS Although the challenges GPs are facing in the long-term follow-up of patients suffering from multimorbidity are increasingly known, the literature currently offers limited information about GPs' clinical reasoning processes at play. GPs tend to underestimate the complexity and richness of their clinical reasoning, which may negatively impact their practice and their teaching.
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Affiliation(s)
- Sarah Cairo Notari
- Primary Care Unit, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland
| | - Julia Sader
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Nathalie Caire Fon
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Johanna Maria Sommer
- Primary Care Unit, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | | | - Danilo Janjic
- Primary Care Unit, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Mathieu Nendaz
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Department of Internal Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Marie-Claude Audétat
- Primary Care Unit, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
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Changes in Daily Life during the COVID-19 Pandemic among South Korean Older Adults with Chronic Diseases: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18136781. [PMID: 34202534 PMCID: PMC8297182 DOI: 10.3390/ijerph18136781] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 06/15/2021] [Accepted: 06/22/2021] [Indexed: 01/22/2023]
Abstract
Amid the COVID-19 pandemic, older adults are considered a high-risk group and have been advised to stay home or practice social distancing. This qualitative study examined the effects of strong quarantine measures and social distancing on older adults’ lifestyles. The participants in this study were 13 people aged 65 and older with chronic diseases who resided in South Korean communities. Qualitative content analysis was conducted to interpret the data collected from in-depth interviews. Four themes and 13 subthemes were identified. The four themes were “lifestyle changes,” “increased cautiousness in daily life,” “psychological changes,” and “adaptation to life during the COVID-19 pandemic.” The participants followed quarantine rules strictly and noted lifestyle changes, such as increased time spent at home due to social distancing guidelines, a smaller radius of daily activity, and changes in exercise and dietary habits. They also reported increased caution toward other people and objects that other people interacted with due to their fear of COVID-19 infection. They expressed fear about COVID-19 infection and anxiety about COVID-19-related news, and they often felt bored and depressed; however, the participants accepted, endured, and gradually adapted to these lifestyle changes. Non-face-to-face community support is urgently needed for older adults facing reduced levels of physical activity and psychological hardships due to the COVID-19 pandemic.
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The Meaning of Work and Self-Management Experiences among Elderly Workers with Multiple Chronic Diseases: A Qualitative Study. Healthcare (Basel) 2020; 8:healthcare8040471. [PMID: 33182428 PMCID: PMC7711449 DOI: 10.3390/healthcare8040471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 10/31/2020] [Accepted: 11/06/2020] [Indexed: 11/17/2022] Open
Abstract
With population aging, increasingly many elderly individuals are expected to participate in economic activities. Elderly workers have a higher prevalence of multiple chronic diseases, making it necessary to examine elderly workers' experiences of health-related self-management in work environments. This qualitative study investigated the meaning of work and health-related self-management experiences among elderly workers with multiple chronic diseases. The study participants were elderly workers residing in South Korea (65 years old or older) with at least two chronic diseases. Twelve participated in individual interviews, which were audio-recorded and transcribed. Qualitative content analysis was conducted with the transcribed data. Six themes, 21 sub-themes, and 40 codes were derived. The themes were "benefit of work on health and life", "adaptation to a new work environment", "endurance", "continuous efforts to maintain health", "difficulties in self-management", and "requirements for health promotion". The participants experienced difficulties in health-related self-management due to time constraints, poor work environment, and financial burdens. However, participants expressed their desire to invest effort into managing their physical and psychological health and to work as long as possible. Programs that consider the aging and health-related characteristics of elderly workers and their work environments should be developed and implemented.
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Joensson ABR, Guassora AD, Freil M, Reventlow S. What the doctor doesn't know: Discarded patient knowledge of older adults with multimorbidity. Chronic Illn 2020; 16:212-225. [PMID: 30213205 DOI: 10.1177/1742395318796173] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVES Adherence to treatment has proven to require the involvement of patients in treatment and care planning. This process involves incorporating patient knowledge, or knowledge about the patients' everyday life, into the clinical encounter. This article explores the disclosure practices of such knowledge from older adults with multimorbidity. METHODS This was an 18-month qualitative study among 14 older adults with multimorbidity living in Denmark. A thematic analysis was applied, focusing on perceptions of patient knowledge and disclosure practices among the participating patients. RESULTS Older adults with multimorbidity have various reasons for not disclosing personal knowledge. The results present three different domains of what we termed discarded patient knowledge: (1) knowledge that had no direct biomedical relevance from participants' perspective; (2) knowledge considered too private; and (3) knowledge assumed to position one as inferior. DISCUSSION The participants made judgments on what they believed was welcome in the clinical encounter, framing their knowledge within the purview of biomedicine. Participants' disclosure practices showed that personal knowledge is sometimes not recognized as important for health and care by participants themselves. Knowledge that could have influenced practitioners' understanding of the problem and provided different solutions, is argued to be discarded patient knowledge.
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Affiliation(s)
- Alexandra B Ryborg Joensson
- Department of Public Health, The Research Unit for General Practice and The Section of General Practice, University of Copenhagen, Copenhagen, Denmark
| | - Ann Dorrit Guassora
- Department of Public Health, The Research Unit for General Practice and The Section of General Practice, University of Copenhagen, Copenhagen, Denmark
| | - Morten Freil
- Knowledge Center for User Involvement in Healthcare, Danish Patients, Copenhagen, Denmark
| | - Susanne Reventlow
- Department of Public Health, The Research Unit for General Practice and The Section of General Practice, University of Copenhagen, Copenhagen, Denmark
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General practitioner strategies for managing patients with multimorbidity: a systematic review and thematic synthesis of qualitative research. BMC FAMILY PRACTICE 2020; 21:131. [PMID: 32611391 PMCID: PMC7331183 DOI: 10.1186/s12875-020-01197-8] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 06/17/2020] [Indexed: 12/21/2022]
Abstract
Background General practitioners (GPs) increasingly manage patients with multimorbidity but report challenges in doing so. Patients describe poor experiences with health care systems that treat each of their health conditions separately, resulting in fragmented, uncoordinated care. For GPs to provide the patient-centred, coordinated care patients need and want, research agendas and health system structures and policies will need to adapt to address this epidemiologic transition. This systematic review seeks to understand if and how multimorbidity impacts on the work of GPs, the strategies they employ to manage challenges, and what they believe still needs addressing to ensure quality patient care. Methods Systematic review and thematic synthesis of qualitative studies reporting GP experiences of managing patients with multimorbidity. The search included nine major databases, grey literature sources, Google and Google Scholar, a hand search of Journal of Comorbidity, and the reference lists of included studies. Results Thirty-three studies from fourteen countries were included. Three major challenges were identified: practising without supportive evidence; working within a fragmented health care system whose policies and structures remain organised around single condition care and specialisation; and the clinical uncertainty associated with multimorbidity complexity and general practitioner perceptions of decisional risk. GPs revealed three approaches to mitigating these challenges: prioritising patient-centredness and relational continuity; relying on knowledge of patient preferences and unique circumstances to individualise care; and structuring the consultation to create a sense of time and minimise patient risk. Conclusions GPs described an ongoing tension between applying single condition guidelines to patients with multimorbidity as security against uncertainty or penalty, and potentially causing patients harm. Above all, they chose to prioritise their long-term relationships for the numerous gains this brought such as mutual trust, deeper insight into a patient’s unique circumstances, and useable knowledge of each individual’s capacity for the work of illness and goals for life. GPs described a need for better multimorbidity management guidance. Perhaps more than this, they require policies and models of practice that provide remunerated time and space for nurturing trustful therapeutic partnerships.
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Determining the Consequences of Perceived Self-Care Ability in Stroke Patients Living at Home: A Qualitative Study in Iran. ARCHIVES OF NEUROSCIENCE 2019. [DOI: 10.5812/ans.95653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Hertroijs DFL, Brouwers MCGJ, Elissen AMJ, Schaper NC, Ruwaard D. Relevant patient characteristics for estimating healthcare needs according to healthcare providers and people with type 2 diabetes: a Delphi survey. BMC Health Serv Res 2019; 19:575. [PMID: 31419980 PMCID: PMC6698036 DOI: 10.1186/s12913-019-4371-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 07/25/2019] [Indexed: 01/02/2023] Open
Abstract
Background Recently, there has been growing interest in providing more tailored, patient-centered care for the treatment of type 2 diabetes mellitus (T2DM). Yet it remains unclear which patient characteristics should be determined to guide such an approach. Therefore, the opinions of healthcare providers (HCP) and people with T2DM about relevant patient characteristics for estimating healthcare needs of people with T2DM were assessed and compared. Methods Two separate online Delphi studies were conducted according to the RAND-UCLA Appropriateness Method: one with HCPs (n = 22) from Dutch primary and secondary care and one with people with T2DM treated in Dutch primary care (n = 46). The relevance of patient characteristics for estimating healthcare needs, defined as the number of yearly consultations, was assessed on a 5-point Likert scale. Characteristics with a median of 4 or 5 and an interquartile range ≤ 1.5 were considered relevant with consensus. Participants were also asked to select the top 5 of most relevant patient characteristics. To determine the overall top 5, the mean relative importance score of each characteristic was calculated. Results In two Delphi rounds, 28 and 15 patient characteristics were rated by HCPs and people with T2DM, respectively. Both HCPs and people with T2DM found health-related characteristics relevant for estimating healthcare needs of people with T2DM. However, HCPs preferred to estimate healthcare needs using person- and context-related characteristics. They ranked self-efficacy as the most relevant estimator. In contrast, people with T2DM were more in favor of health-related characteristics and ranked HbA1c as the most relevant estimator. Conclusions The findings show that there is discrepancy in opinions on relevant patient characteristics for estimating healthcare needs between HCPs and people with T2DM. To achieve more tailored, patient-centered care, it is important that both groups agree on the topics to be discussed during patient consultations. Electronic supplementary material The online version of this article (10.1186/s12913-019-4371-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Dorijn F L Hertroijs
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Duboisdomein 30, 6229, GT, Maastricht, the Netherlands.
| | - Martijn C G J Brouwers
- Department of Internal Medicine, Division of Endocrinology and Metabolic Diseases, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX, Maastricht, the Netherlands
| | - Arianne M J Elissen
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Duboisdomein 30, 6229, GT, Maastricht, the Netherlands
| | - Nicolaas C Schaper
- Department of Internal Medicine, Division of Endocrinology and Metabolic Diseases, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX, Maastricht, the Netherlands
| | - Dirk Ruwaard
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Duboisdomein 30, 6229, GT, Maastricht, the Netherlands
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Kristensen MAT, Guassora AD, Arreskov AB, Waldorff FB, Hølge-Hazelton B. 'I've put diabetes completely on the shelf till the mental stuff is in place'. How patients with doctor-assessed impaired self-care perceive disease, self-care, and support from general practitioners. A qualitative study. Scand J Prim Health Care 2018; 36:342-351. [PMID: 29929420 PMCID: PMC6161682 DOI: 10.1080/02813432.2018.1487436] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE This paper investigated patients' experiences of disease and self-care as well as perceptions of the general practitioner's role in supporting patients with impaired self-care ability. DESIGN Qualitative interviews with 13 patients with type 2 diabetes, concurrent chronic diseases, and impaired self-care ability assessed by a general practitioner. We analyzed our data using systematic text condensation. The shifting perspectives model of chronic illness formed the theoretical background for the study. RESULTS Although most patients experienced challenges in adhering to recommended self-care activities, many had developed additional, personal self-care routines that increased wellbeing. Some patients were conscious of self-care trade-offs, including patients with concurrent mental disorders who were much more attentive to their mental disorder than their somatic diseases. Patients' perspectives on diseases could shift over time and were dominated by emotional considerations such as insisting on leading a normal life or struggling with limitations caused by disease. Most patients found support in the ongoing relationship with the same general practitioner, who was valued as a companion or appreciated as a trustworthy health informant. CONCLUSION Patient experiences of self-care may collide with what general practitioners find appropriate in a medical regimen. Health professionals should be aware of patients' prominent and shifting considerations about the emotional aspects of disease. Patients valued the general practitioner's role in self-care support, primarily through the long-term doctor-patient relationship. Therefore, relational continuity should be prioritized in chronic care, especially for patients with impaired self-care ability who often have a highly complex disease burden and situational context. Key points Little is known about the perspectives of disease and self-care in patients with a doctor-assessed impaired ability of self-care. • Although patients knew the prescribed regimen they often prioritized self-care routines that increased well-being at the cost of medical recommendations. • Shifting emotional aspects were prominent in patients' considerations of disease and sustained GPs' use of a patient-centred clinical method when discussing self-care. • Relational continuity with general practitioners was a highly valued support and should be prioritized for patients with impaired self-care.
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Affiliation(s)
- Mads Aage Toft Kristensen
- Department of Public Health, The Research Unit for General Practice and Section of General Practice, University of Copenhagen, Copenhagen, Denmark;
- Southern Køge Medical Centre, Køge, Denmark;
- CONTACT Mads Aage Toft KristensenDepartment of Public Health, The Research Unit for General Practice and Section of General Practice, University of Copenhagen, Øster Farimagsgade 5, P.O. box 2099, Copenhagen K, DK, 1014, Denmark
| | - Ann Dorrit Guassora
- Department of Public Health, The Research Unit for General Practice and Section of General Practice, University of Copenhagen, Copenhagen, Denmark;
| | - Anne Beiter Arreskov
- Department of Public Health, The Research Unit for General Practice and Section of General Practice, University of Copenhagen, Copenhagen, Denmark;
| | - Frans Boch Waldorff
- Department of Public Health, The Research Unit for General Practice and Section of General Practice, University of Copenhagen, Copenhagen, Denmark;
- Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Odense, Denmark;
| | - Bibi Hølge-Hazelton
- Zealand University Hospital, Roskilde, Denmark;
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
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Riegel B, Barbaranelli C, Sethares KA, Daus M, Moser DK, Miller JL, Haedtke CA, Feinberg JL, Lee S, Stromberg A, Jaarsma T. Development and initial testing of the self‐care of chronic illness inventory. J Adv Nurs 2018; 74:2465-2476. [DOI: 10.1111/jan.13775] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 04/21/2018] [Accepted: 06/12/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Barbara Riegel
- School of Nursing University of Pennsylvania Philadelphia Pennsylvania
| | | | | | - Marguerite Daus
- School of Nursing University of Pennsylvania Philadelphia Pennsylvania
| | - Debra K. Moser
- College of Nursing University of Kentucky Lexington Kentucky
| | | | | | | | - Solim Lee
- School of Nursing University of Pennsylvania Philadelphia Pennsylvania
| | - Anna Stromberg
- Division of Nursing and Department of Cardiology Department of Medical and Health Sciences Linkoping University Linkoping Sweden
| | - Tiny Jaarsma
- Faculty of Medicine and Health Linkoping University Linkoping Sweden
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'More constricting than inspiring' - GPs find chronic care programmes of limited clinical utility. A qualitative study. BJGP Open 2018; 2:bjgpopen18X101591. [PMID: 30564724 PMCID: PMC6184093 DOI: 10.3399/bjgpopen18x101591] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 03/01/2018] [Indexed: 11/21/2022] Open
Abstract
Background As in other countries, Danish health authorities have introduced disease management programmes (DMPs) to improve care quality. These contain clinical practice guidelines (CPGs) and guidelines for patient stratification based on doctors’ assessments of disease severity and self-care. However, these programmes are challenged when patients have complex chronic conditions. Aim To explore how GPs experience the clinical applicability of disease management programmes for patients with multiple chronic conditions and lowered self-care ability. Design & setting A qualitative study from general practice, conducted in rural areas of Denmark with economically disadvantaged populations. Method Data were collected through case-based, semi-structured interviews with 12 GPs. The principles of systematic text condensation were used in the analysis. Results GPs found DMPs inadequate, particularly for patients with multiple conditions and lowered self-care ability. Their experience was that adhering to multiple programmes’ CPGs resulted in too much medication, conflicting treatments, an overload of appointments, and fragmented health care. They disregarded stratifying according to guidelines because they deemed stratification criteria to reflect neither patients’ need for self-care support, nor flexible referral options to hospitals and municipalities. Therefore, GPs were often solely responsible for treatment of patients with very complex chronic conditions. Conclusion GPs found DMPs to be of limited clinical applicability due to challenges related to CPGs, patient stratification, and lack of adequate health services to support patients with complex healthcare needs. To increase the benefits of these programmes, they should be more flexible, and adjusted to the needs of patients with multiple chronic conditions and lowered self-care ability.
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